Diabetic Skin Infections

People with diabetes are more prone to skin problems than people who do not have diabetes. As many as one-third of people afflicted with diabetes will have a diabetes-related skin disorder at some time in their lives. In fact, skin problems are sometimes the first signs that a person has diabetes. There are two reasons for this and both have to do with elevated blood sugar levels. First, many infection-causing microorganisms feed on the excess glucose in the blood of diabetics. On the other hand, the higher than normal glucose levels impair the immune system that fights infections.

When blood glucose levels are high, the body loses fluid and the resulting dehydration can lead to dry skin on the legs, feet and elbows. Rough, dry and scaly skin affects at least 75 percent of people over the age of 64 who have diabetes. Dry skin can crack, letting germs that can cause infections into the body.

Diabetes also affects the nerves (neuropathy). This can make the skin less sensitive to pain. People with diabetes often have reduced nerve sensitivity and circulation in their hands and feet thereby causing difficulty in detecting and identifying skin problems. Sometimes skin wounds become infected without the patient realizing it. Bacterial and fungal infections occur commonly.

Bacterial Infections
Different kinds of bacterial infections affect the skin. Skin infections with the bacteria known as Staphylococcus are more common and more serious in people with poorly controlled diabetes. Infection can develop after an injury or wound to the skin such as a cut or scrape, a bite or sting, a tattoo or piercing. When bacteria enter irritated or injured skin at or near the site of a skin growth, an infection may develop. These bacteria can result in ‘boils’ or inflamed nodules from hair follicles, which can occur in areas where hair follicles can be irritated.

Signs of infection may include:
• Increased pain, swelling, redness, or warmth around the affected area.
• Red streaks extending from the affected area.
• Drainage of pus from the area.
• Fever or chills with no other known cause.
• Swollen lymph nodes in the neck, armpit, or groin.

Fungal infections
Both fungi and bacteria feed on high glucose levels, and the skin is a favorite site for fungi to flourish. A yeast-like fungus called Ciandida albicans is responsible for many of the fungal infections affecting people with diabetes. Women in particular are prone to infection with this fungus in the vagina.

Other commonly seen areas of infection include the corners of the mouth with what is known as “angular cheilitis,” which feels like small cuts on the corners of the mouth. Fungi can also infect in between the toes and fingers and in the nails (onychomycosis). The fungi create itchy, bright red rashes, often surrounded by tiny blisters and scales. These infections most often occur in warm, moist folds of the skin.

Three common fungal infections are: jock itch (red, itchy area on the genitals and the inside of the thighs), althlete’s foot (affects the skin between the toes), and ringworm (ring-shaped, scaly patches that can itch or blister and appear on the feet, groin, chest and abdomen, scalp or nails).

Drugs that kill the susceptible fungus (anti-mycotic medications), both topical and systemic are usually needed to treat these infections.

Foot Ulcers
Of special concern among diabetics are the so-called foot ulcers. An ulcer is an open sore, and diabetics are especially prone to foot ulcers that may become infected. Among the plausible explanations for this susceptibility to foot ulcers include: the difficulty of examining the feet, especially for those who are overweight, and as previously mentioned, neuropathy which can leave foot wound undetected.

Cardiovascular complications may also limit the blood supply to the feet and legs, impairing the immune system’s ability to fight infections. This is especially true for smokers. Smoking narrows the blood vessels, impairing healing even more. An estimated 95 percent of foot and leg amputations among diabetics happen to smokers.

Caring for Your Skin
Fortunately, most skin conditions can be prevented and successfully treated if caught early. But if not cared for properly, a minor skin condition can turn into a serious problem with severe consequences.
There are several things you can do to head off skin problems:
• Keep your diabetes under control. This is the most important factor in preventing the skin-related complications of diabetes. Follow your health care provider’s advice regarding exercise, and medication. Keep your blood glucose level the range recommended by your doctor. By maintaining normal glucose levels, immune system works properly.
• Drink plenty of fluids.
• Protect your skin. For example , wear gloves when using cleaners, solvents and other household detergents.
• Avoid taking long baths and washing excessively, as this can also cause loss of oil in the outer layers of the skin, causing further dryness.
• Bathe or shower in warm (not hot) water, as hot water can dry out skin. Moisturizing soaps may help. Afterward, use a light moisturizing skin cream/lotion.
• Dry skin well after bathin or showering and then check for any areas that may be slightly red or particularly dry, as they may need special attention.
• Wash minor cuts thoroughly with soap and water and then apply an antibiotic ointment. If cuts, scrapes, or burns become swollen, warm, tender or ooze pus, immediate doctors’ consultation is essential.
• Take good care of your feet. Check them everyday for sores and cuts. Wear broad, flat shoes that fit well. Check your shoes for foreign objects before putting them on. Take special care during grooming procedures like nail cutting and pedicure.
• Seek professional advice.

As with most afflictions, vigilance, as well as early detection and treatment of skin disorders can prevent development of more serious complications.

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